St. Louis-area Superbowl viewers used to amusing television commercials hawking the latest products were rattled out of complacency by a public service announcement about drug overdose. The ad, to which viewers had diverse emotional responses, ended with a mother helplessly holding her son who had overdosed on heroin. But if innovative state and federal legislators have their way, parents in this heartbreaking situation could gain access to a medication that could avert such a horrifying outcome.
For example, in the state with the nation’s worst opioid overdose crisis, West Virginia Governor Earl Ray Tomblin recently announced that he wants police, firefighters and family members of drug users to be able to carry naloxone. In doing so, he joined a growing number of elected officials, law enforcement officers and public health experts who have been touting the benefits of an old medication that even many physicians had barely heard of a few years ago.
Naloxone was developed in the 1960s and was employed in urban emergency rooms during the heroin epidemic of that period. The medication is an "antagonist" for opioids, meaning that it blocks drugs like heroin and hydrocodone from exerting their effect in the brain. When naloxone is administered, opioids are rapidly forced out of brain receptors. The effects of opioids – most notably the potentially fatal suppression of breathing – are reversed as a result.
When the heroin epidemic of the 1960s and 1970s waned, many people forgot about naloxone. Not only was there less need for it, but once its patent expired there was no financial incentive for drug manufacturers to continuing marketing it to prescribers. But over the past 15 years the explosion of U.S. opioid prescribing generated a new epidemic of addiction to drugs such as oxycodone, which more recently has cascading into rising heroin use as well. As the annual number of opioid overdoses began climbing, naloxone had a renaissance, particularly the possibility of moving it out of the emergency room and into the community where non-physicians could use it in overdose emergencies.
Research on how expanding access to naloxone affects overdose death rates is at a preliminary stage, but all signs so far are encouraging. A recent evaluation of a program that trained community members how to recognize and respond to opioid overdose (including how to administer naloxone) found a decrease in community-wide overdose death rates. Since police in Quincy, Massachusetts began carrying naloxone, they have been reversing about one overdose every 10 days.
The White House Office of National Drug Control Policy reports that over a third of the states have passed naloxone access legislation and companion “Good Samaritan” provisions. Civil liability protections for police officers who carry naloxone and physicians who make it available to community members (e.g., the parent of a heroin-addicted teenager) are common Good Samaritan provisions. Good Samaritan provisions also sometimes grant immunity from drug possession charges to drug users who contact 911 during an overdose crisis.
Naloxone does not always succeed in reversing an overdose, does not remove any underlying addiction and does not obviate the need for medical care for overdose. Yet it remains life-saving in many circumstances. Given the flurry of state-level legislation and the fact that a bipartisan group of U.S. Senators are pushing to help more states equip first responders with naloxone, it seems likely that more communities will be using naloxone in the coming years to reduce the deadly toll of opioid overdose.
Keith Humphreys is a Professor and Director of Mental Health Policy at Stanford University School of Medicine. You can follow him on Twitter @KeithNHumphreys